Medicare Benefits Schedule - Item 82001

Attendance by an eligible allied health practitioner, as a member of a multidisciplinary case conference team, to participate in a community case conference if the conference lasts for at least 15 minutes, but for less than 20 minutes (other than a service associated with a service to which another item in this Group applies)

Fee: $53.75 Benefit: 85% = $45.70

(See para MN.10.4 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $161.25

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These allied health items provide MBS benefits for eligible allied health professionals to participate in a multidisciplinary case conference team in a community case conference with a patient’s medical practitioner and other providers.

A multidisciplinary case conference means a process by which a multidisciplinary case conference team carries out all of the following activities:

• discussing a patient’s history;
• identifying the patient’s multidisciplinary care needs;
• identifying outcomes to be achieved by members of the multidisciplinary case conference team giving care and service to the patient;
• identifying tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the multidisciplinary case conference team;
• assessing whether previously identified outcomes (if any) have been achieved.

These items apply to non-hospital admitted patients who are under 25 years old and have either been diagnosed with, or are suspected of having:

• a complex neurodevelopmental disorder (such as autism spectrum disorder); or
• an eligible disability.

Eligible allied health professionals may claim reimbursement for participating in case conferences through three time-tiered items:

• 15–19 minutes (82001)
• 20–39 minutes (82002)
• over 40 minutes (82003)

There are no frequency restrictions for case conferencing items for patients with or suspected of having a complex neurodevelopmental disorder or an eligible disability.

Eligible allied health professionals

For the purposes of these items, eligible allied health professional means:

• an eligible Aboriginal health worker;
• an eligible Aboriginal and Torres Strait Islander health practitioner;
• an eligible psychologist;
• an eligible speech pathologist;
• an eligible occupational therapist;
• an eligible audiologist;
• an eligible optometrist;
• an eligible mental health nurse;
• an eligible mental health worker;
• an eligible orthoptist; or
• an eligible physiotherapist.

Eligible health professionals must meet the eligibility requirements as set out in the Health Insurance (Section 3C General Medical Services – Allied Health Services) Determination 2024.

Eligible patients

These items apply to non-hospital admitted patients who are under 25 years old and have either been diagnosed with, or are suspected of having:

• a complex neurodevelopmental disorder; or
• an eligible disability.

Organisation of a case conference

The case conference must be organised by the medical practitioner. The multidisciplinary case conference team must include a medical practitioner and at least 2 other members providing different kinds of care to the patient. The multidisciplinary case conference team requirements include:

• each member must provide a different kind of care or service to the patient; and
• each member must not be an unpaid carer of the patient; and
• one member may be another medical practitioner.

The patient and family members or carers can attend the case conference but will not count towards the minimum team member requirements.

The eligible allied health professional does not need all participants to be MBS-eligible to be able to claim payment for their participation. Members can include allied health professionals, home and community service providers and care organisers, including the following:

• Aboriginal and Torres Strait Islander health practitioners
• asthma educators
• audiologists
• dental therapists
• dentists
• diabetes educators
• dieticians
• mental health workers
• occupational therapists
• optometrists
• orthoptists
• orthotists or prosthetists
• pharmacists
• physiotherapists
• podiatrists
• psychologists
• registered nurses
• social workers
• speech pathologists
• education providers
• “meals on wheels” providers
• personal care workers
• probation officers

In some instances, 2 eligible allied health professionals from the same profession may participate in the same case conference, where both provide different aspects of care to the patient. For example, the 2 providers from the same profession have different specialisations that are clinically relevant to the same patient and cannot be provided by one of the providers alone. In this instance, both providers will be able to claim the new items.

Participation in a case conference

A referral is not required for eligible allied health professionals to access the allied health case conferencing items for complex neurodevelopmental disorder and disability services. However, the allied health professional must be invited to participate in the case conference by the patient’s treating medical practitioner.

The patient must agree to the allied health professional participating in the case conference and be informed that Medicare will be accessed to fund the service. The patient may agree through discussion with their medical practitioner. The allied health professional should ensure that the patient has agreed and that their agreement has been recorded appropriately.

Allied health professionals claiming a case conferencing item should record the day, start and end times, the names of all participants and all matters discussed in the patient’s medical record.

The allied health professional is not required to have a pre-existing relationship with the patient. However, the patient must agree to the allied health professional participating in the case conference and be informed that Medicare will be accessed to fund the service.

The case conference may lead to an agreed care plan between all participating providers, including the number of allied health professional services required and how they are allocated among eligible allied health professionals within a patient’s entitlement.

The case conferencing items can be accessed in person, via videoconference or telephone, using the same item number. There is no requirement that all participants use the same communication method.

Related Items: 82001 82002 82003